MEDICARE: DR. PAIGE MCCRYSTLE MCCLELLAND DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901022229	MI

General Provider Information

NPI Number	:	1578093852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAIGE MCCRYSTLE MCCLELLAND DDS

Provider Business Mailing Address
First Line	:	341 W HARRISON AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3115
Country	:	US
Telephone Number	:	248-496-6115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 N ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-1188
Country	:	US
Telephone Number	:	248-651-1594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	06/19/2017

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